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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Co-Treatment and Group Therapy


Co-treatment is defined as two different therapy disciplines performing therapy on the same patient at the same time by a licensed therapist and rendered in accordance with the Executive Council of Physical Therapy and Occupational Therapy Examiners and State Board of Examiners for Speech-Language Pathology and Audiology.

Co-treatment may be a benefit when it is medically necessary for the patient to receive therapy from two different therapy disciplines at the same time. The therapy performed requires the expertise of two different disciplines (i.e., licensed physical therapist, licensed occupational therapist, or licensed speech-language pathologist), to perform the therapy safely and effectively to reach the client’s goals as determined by the approved plan of care, signed and dated by the patient’s prescribing provider.

When performing co-treatment, a primary therapist must be designated by the two performing therapists. Only the primary performing therapist may bill for the therapy services rendered. The secondary therapist will not be reimbursed for assisting a designated primary performing therapist.

The following co-treatment documentation requirements must be maintained in the patient’s medical records as follows:

  • Medical necessity for the individual therapy services must be justified before performing cotreatment.
  • Documentation supports co-treatment goals and how co-treatment will help the therapist achieve the therapist’s goals for the patient, for each therapy discipline.
  • An explanation of why the client requires and will receive multi-disciplinary team care, defined as at least two therapy disciplines (physical, occupational, or speech therapy) during the same therapy session.

Retrospective review may be performed to ensure documentation supports that the medical necessity of the co-treatment performed and that the billing was appropriate for the services provided by the designated primary-performing therapist.

Therapy Co-Treatment Modifier

Modifier: U3

Group Therapy

Group therapy consists of simultaneous treatment to two or more patients who may or may not be doing the same activities. If the therapist is dividing attention among the patients, providing only brief, intermittent personal contact, or giving the same instructions to two or more patients at the same time, the treatment is recognized as group therapy. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one client contact is not required.

The following requirements must be met in order to meet the Texas Medicaid criteria for group therapy:

  • Prescribing provider’s prescription for group therapy.
  • Performance by or under the general supervision of a qualified licensed therapist as defined by licensure requirements.
  • The licensed therapist involved in group therapy services must be in constant attendance (in the same room) and active in the therapy.
  • Each patient participating in the group must have an individualized treatment plan for group treatment, including interventions and short-and long-term goals and measurable outcomes.

Texas Medicaid does not limit the number of patients who can participate in a group therapy session. Providers are subject to certification and licensure board standards regarding group therapy.

Group Therapy Documentation Requirements

The following documentation must be maintained in the patient’s medical record:

  • Prescribing provider’s prescription for group therapy.
  • Individualized treatment plan that includes frequency and duration of the prescribed group therapy and individualized treatment goals.
  • Name and signature of licensed therapist providing supervision over the group therapy session.
  • Specific treatment techniques utilized during the group therapy session and how the techniques will restore function.
  • Start and stop times for each session.
  • Group therapy setting or location.
  • Number of patients in the group.


Texas Medicaid Provider Manual

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook

June 2022

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